Download Transient Osteoporosis

Spine University’s Guide to
Transient Osteoporosis
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Spine University's Guide to Transient Osteoporosis
Compliments of: Spine University
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Spine University's Guide to Transient Osteoporosis
Introduction
The word osteoporosis scares many people
because they’ve heard about brittle bone
disease. They may know someone who has
had it or seen pictures of women with severely
humped backs (called kyphosis) as a result of
osteoporosis. However, transient osteoporosis
isn’t the same thing nor does it end up in the
same way. The only thing osteoporosis and
transient osteoporosis have in common is that
they both affect the bones.
Transient osteoporosis (TO) is a condition that
affects your bone marrow, the pulpy tissue
found inside your body's long bones such as
the ribs, breastbone or pelvis. Bone marrow
produces red blood cells, white blood cells and
platelets.
Doctors don't know yet what causes transient
osteoporosis. They do know that there's no
connection between the disease and whether
you've been injured or ill. Therefore, injuring
or breaking a hip or knee doesn’t cause transient osteoporosis.
The disease was first identified in 1959 as
bone marrow edema (BME), inflammation of
the bone marrow. Transient osteoporosis has
been called transient osteonecrosis of the hip,
regional migratory osteoporosis, transient bone
marrow edema syndrome, and even reflex
sympathetic dystrophy. It has been called
many different things before researchers settled
on transient osteoporosis.
Who is affected by transient
osteoporosis?
Transient osteoporosis most often affects men
who are between 40 and 70 years of age and
women who are in their last trimester of pregnancy (the final three months). The women,
however, are a very small group compared
with the men. Transient osteoporosis is rarely
seen outside of these two groups of people.
What are the symptoms of transient osteoporosis (TO)?
Unlike the more well known osteoporosis,
which begins very slowly, transient osteoporosis comes on very suddenly and sharply,
without warning. The most common area
affected is the hip. As a result, the pain from
transient osteoporosis can be felt in the groin,
buttocks, or thighs. The pain can feel deep
and radiate outwards. Although it does most
often affect the hip, transient osteoporosis can
also affect the other weight-bearing joints: the
knees, ankles, and feet.
The pain comes as a surprise because it isn’t
caused by a trauma or injury. In fact, it's
usually quite puzzling to the patient. After the
sudden onset, the pain usually worsens over
a few weeks and can become so severe to the
point of being disabling. The pain worsens
with movement or on weight-bearing and
can ease off a bit when the patient is at rest,
although that isn’t the case for everyone.
Turning is the worst type of movement for
aggravates the pain.
Along with the pain, your gait, or way of
walking, usually changes because you end up
trying to protect the sore joint. This causes
a limp, which in turn can end up causing
muscular pain or even joint pain in other parts
of your body as you unconsciously try to
compensate for the change in gait.
The symptoms usually begin to start easing
off within four to nine months, but doctors
are unable to tell who will start feeling better
earlier than later.
Can transient osteoporosis come
back?
Transient osteoporosis can return to affect
the same joints or it can begin in another
joint. Again, because doctors don't know
what causes it, they can't predict who will
get it again. It starts just as suddenly as it did
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Spine University's Guide to Transient Osteoporosis
the first time with the same type of pain and
progress. How long you've had it the first time
doesn't indicate how long it would be a second
time, though.
How is transient osteoporosis
diagnosed?
When you see a doctor about the pain caused
by transient osteoporosis, your doctor will
do a physical examination to look for certain
signs and symptoms that may suggest what
the problem is. At the same time though, he or
she will use this time to rule out problems that
can't be causing the pain.
If the pain is in the hip, for example, your
doctor will check the range of motion, how
well you can move the hip as it should be able
to move. Although blood tests can't show if
you have transient osteoporosis, your doctor
will likely order them because they tests will
look for other illnesses or disorders that could
be causing the pain. These tests are to rule out
these other disorders.
X-rays are a common test when there's pain
that seems to be coming from a joint or bone.
Around three to six weeks after the pain has
started, doctors should be able to see some
changes in the bone and these changes are still
often visible for weeks after the pain has gone
away. In some cases, the changes have been
visible on x-ray for up to two years after the
first signs of pain.
There is a test called a bone scintigraphy
that is sometimes done when people have
complaints of joint or bone pain. This test
shows changes in the bone metabolism
(changes that take place in the cells), unlike
x-rays, which show how the bone structure
looks at the precise time that the x-ray was
taken. A bone scintigraphy can show changes
before they're obvious by x-ray. The test is
done by watching how a tracer, or dye, moves
through the bone structure. Several images
are taken over the course of a few hours.
Scinitigraphy isn’t used for diagnosis only; the
test is a good way to follow the progress of the
disease and see how well you are healing.
Computed tomography or CT scans, are
another tool in the doctor's diagnostic toolbox.
It's not as effective as scintigraphy because it
isn’t sensitive enough to small changes, but it
may give your doctor a good idea of what is
going on. Another test often mentioned in the
same breath as a CT scan is magnetic resonance imaging or MRI. While CT scans use
radiation (like x-rays) MRIs use magnets to
capture images from inside the body. When
looking for transient osteoporosis, MRIs can
be very good at detecting the presence of bone
marrow edema, so it's more effective than a
CT scan.
What other diseases might the
doctor think it is at first?
When you first go to see a doctor with
any type of medical problem and a list of
symptoms, unless he or she can recognize
the issue right away, you are a puzzle that
needs to be solved. Your doctor will take into
account what you say and what your physical
examination show to come up with what is
called a differential diagnosis. This is a list
of illnesses or disorders that could be causing
your problem. Once your doctor has this list of
possible causes, he or she can start working on
eliminating what it can't be and discover what
the actual problem is.
The list of possible causes for your pain if you
have transient osteoporosis include:
Regional migratory osteoporosis (RMO). This
disease causes pain in many weight-bearing
joints. It most often affects middle-aged
men, much like transient osteoporosis. And,
it begins much the same. However, unlike
transient osteoporosis, regional migratory
osteoporosis affects mostly the knee, ankle,
and foot, rarely the hip. Physically, it's also
quite different. If you had regional migratory
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Spine University's Guide to Transient Osteoporosis
osteoporosis, your doctor would be able to feel
a warm and swollen area around the joint and
you would have a decreased range of motion
with severe pain. Transient osteoporosis
doesn’t have that swollen, warm, and tender
finding.
often encouraged. When you don't use your
leg and avoid putting any weight at all on the
joints for a while, this may help the joint that
has been damaged. But researchers have found
that this may also prolong the course of the
disease.
Osteonecrosis. This is not a common problem
but it does occur in about 15,000 people in
the United States every year. Although it can
be genetic (run in families), there are also
some things that may cause it or increase a
person's risk for developing it. Like transient
osteoporosis and RMO, osteonecrosis affects
the weight-bearing joints most often, but with
the hip the most common one affected. It also
affects mostly middle-aged men but it's also
been seen in women over 55 years old.
You may also be given medications, such as
analgesics (pain relievers) and/or nonsteroidal
anti-inflammatories (NSAIDs), which are
medications that reduce inflammation but
without using steroids. In the past, some
doctors used corticosteroids to help with
treatment, but they weren't found to be very
effective.
Neoplasia. This is a type of cancer, which can
be detected by CT scan, as well as the other
bone tests.
Inflammatory arthritis. There are a few types
of arthritis that could mimic the signs and
symptoms of transient osteoporosis. Usually,
this can be ruled out fairly early in the diagnosis because arthritis can be seen on x-ray
and MRIs.
How is transient osteoporosis
treated?
Transient osteoporosis is what the doctors call
a self-limiting disease. This means that the
disease will run its course and then go away,
much like a cold does. For this reason, there
aren't many treatments that can be done for the
transient osteoporosis itself, although there are
treatments for the pain and disability that can
occur while the disease is active.
Your doctor may suggest that you use
crutches, canes, or some other walking aid for
partial-weight bearing. In other words, you
want some method to keep you from putting
too much weight and stress on your sore joint.
Non-weight bearing has drawbacks and isn't
Some patients find some relief of joint pain
by doing aquatic (water) exercises. Aquatic
exercises are often recommended for people
who have joint problems because they take the
weight off the joints but allow you to move
about freely. Physiotherapy and exercises to
maintain strength and flexibility may also be
suggested.
One of the complications of transient osteoporosis is the reduction in bone strength as
the disease progresses. This is a challenge for
doctors because if your bones become too
week, this could result in other complications,
such as fractures or breaks. To prevent this
from becoming a problem, your doctor will
want you to continue the partial weight bearing
(or protective weight bearing) to reduce your
risk of injuring the joint. As well, some doctors
may try to strengthen the bone, making it less
liable to being injured. This means giving you
a medication from the bisphosphate family
of drugs, which are given for osteoporosis.
In one study looking at the treatment of transient osteoporosis, researchers gave patients a
medication called pamidronate by intravenous
(directly into the vein). They found that this
helped somewhat and the results were encouraging. The research using this medication is
continuing.
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Spine University's Guide to Transient Osteoporosis
In the meanwhile, researchers are emphasizing
that the earlier transient osteoporosis is diagnosed, the earlier doctors can be proactive at
keeping patients' bones strong by prescribing
bone-strengthening treatments, such as
calcium, vitamin D, and bisphosphonates.
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Spine University's Guide to Transient Osteoporosis
Notes
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